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Gerrard AD, Garau R, Xu W, Maeda Y, Dunlop MG, Theodoratou E, Din FVN. Repeat Faecal Immunochemical Testing for Colorectal Cancer Detection in Symptomatic and Screening Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:3199. [PMID: 39335170 PMCID: PMC11429846 DOI: 10.3390/cancers16183199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/03/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Faecal immunochemical testing (FIT) is widely used in bowel screening programmes and assessing symptomatic patients for suspected colorectal cancer (CRC). The evidence for single test performance of FIT in both settings is considerable; however, the use of a repeat test to increase sensitivity remains uncertain. We aimed to review what increase in test positivity would be generated by additional FITs, whether a repeated FIT detects previously missed CRC and advanced colorectal neoplasia (ACRN), and to estimate the sensitivity of double-FIT strategies to diagnose CRC and ACRN. METHODS A systematic search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed using key search terms. Studies reporting the use of more than one FIT in the same screening round or planned assessment of a single symptomatic patient episode were included. Studies were categorised by the reported study population into asymptomatic, mixed (cohorts of combined asymptomatic, symptomatic, or high-risk surveillance), or symptomatic cohorts. RESULTS A total of 68 studies were included for analysis (39 asymptomatic, 21 mixed, 7 symptomatic, and 1 study with discrete asymptomatic and symptomatic data). At a threshold of 10 µg Hb/g, the two-test positivity ranged between 8.1 and 34.5%, with an increase from the second test of 3-9.2 percentage points. Four out of five studies comparing one versus two tests for diagnosing CRC at 10 µg Hb/g identified additional cases with the second test, with a minimum of 50% reduction in missed CRC. At a threshold of 20 µg Hb/g, the second test increased the positivity by 1.3-6.7 percentage points, with a two-test positivity of between 5.1 and 25.0%. Using a threshold of 20 µg Hb/g, five out of seven studies had a 25% reduction in missed CRC. A meta-analysis estimated the double-FIT sensitivity at 10 µg Hb/g for CRC in mixed-risk and symptomatic cohorts to be 94% and 98%, respectively. CONCLUSIONS Repeated use of FIT helps to diagnose more cases of CRC with a moderate increase in positivity. A double-FIT strategy at 10 µg Hb/g in mixed and symptomatic cohorts has a very high sensitivity for CRC.
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Affiliation(s)
- Adam D. Gerrard
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh EH4 2XR, UK; (A.D.G.); (E.T.)
- Department of Colorectal Surgery, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Roberta Garau
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh EH4 2XR, UK; (A.D.G.); (E.T.)
- Department of Colorectal Surgery, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Wei Xu
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh EH4 2XR, UK; (A.D.G.); (E.T.)
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh EH4 2XR, UK
| | - Yasuko Maeda
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G12 8QQ, UK
- Department of Surgery, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Malcolm G. Dunlop
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh EH4 2XR, UK; (A.D.G.); (E.T.)
- UK Colon Cancer Genetics Group, Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics & Cancer, Western General Hospital, The University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Evropi Theodoratou
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh EH4 2XR, UK; (A.D.G.); (E.T.)
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh EH4 2XR, UK
| | - Farhat V. N. Din
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh EH4 2XR, UK; (A.D.G.); (E.T.)
- Department of Colorectal Surgery, Western General Hospital, Edinburgh EH4 2XU, UK
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Abbes S, Baldi S, Sellami H, Amedei A, Keskes L. Molecular methods for colorectal cancer screening: Progress with next-generation sequencing evolution. World J Gastrointest Oncol 2023; 15:425-442. [PMID: 37009313 PMCID: PMC10052664 DOI: 10.4251/wjgo.v15.i3.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 02/14/2023] [Indexed: 03/14/2023] Open
Abstract
Currently, colorectal cancer (CRC) represents the third most common malignancy and the second most deadly cancer worldwide, with a higher incidence in developed countries. Like other solid tumors, CRC is a heterogeneous genomic disease in which various alterations, such as point mutations, genomic rearrangements, gene fusions or chromosomal copy number alterations, can contribute to the disease development. However, because of its orderly natural history, easily accessible onset location and high lifetime incidence, CRC is ideally suited for preventive intervention, but the many screening efforts of the last decades have been compromised by performance limitations and low penetrance of the standard screening tools. The advent of next-generation sequencing (NGS) has both facilitated the identification of previously unrecognized CRC features such as its relationship with gut microbial pathogens and revolutionized the speed and throughput of cataloguing CRC-related genomic alterations. Hence, in this review, we summarized the several diagnostic tools used for CRC screening in the past and the present, focusing on recent NGS approaches and their revolutionary role in the identification of novel genomic CRC characteristics, the advancement of understanding the CRC carcinogenesis and the screening of clinically actionable targets for personalized medicine.
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Affiliation(s)
- Salma Abbes
- Laboratory of Parasitic and Fungal Molecular Biology, University of Sfax, Sfax 3029, Tunisia
| | - Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Hayet Sellami
- Drosophila Research Unit-Parasitology and Mycologie Laboratory, University of Sfax, Sfax 3029, Tunisia
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
- SOD of Interdisciplinary Internal Medicine, Careggi University Hospital, Florence 50134, Italy
| | - Leila Keskes
- Laboratory of Human Molecular Genetic, University of Sfax, Sfax 3029, Tunisia
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3
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Biomarkers to Detect Early-Stage Colorectal Cancer. Biomedicines 2022; 10:biomedicines10020255. [PMID: 35203465 PMCID: PMC8869393 DOI: 10.3390/biomedicines10020255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is a leading cause of mortality worldwide. The high incidence and the acceleration of incidence in younger people reinforces the need for better techniques of early detection. The use of noninvasive biomarkers has potential to more accurately inform how patients are prioritised for clinical investigation, which, in turn, may ultimately translate into improved survival for those subsequently found to have curable-stage CRC. This review surveys a wide range of CRC biomarkers that may (alone or in combination) identify symptomatic patients presenting in primary care who should be progressed for clinical investigation.
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4
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Druce P, Calanzani N, Snudden C, Milley K, Boscott R, Behiyat D, Martinez-Gutierrez J, Saji S, Oberoi J, Funston G, Messenger M, Walter FM, Emery J. Identifying Novel Biomarkers Ready for Evaluation in Low-Prevalence Populations for the Early Detection of Lower Gastrointestinal Cancers: A Systematic Review and Meta-Analysis. Adv Ther 2021; 38:3032-3065. [PMID: 33907946 PMCID: PMC8078393 DOI: 10.1007/s12325-021-01645-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/30/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Lower gastrointestinal (GI) cancers are a major cause of cancer deaths worldwide. Prognosis improves with earlier diagnosis, and non-invasive biomarkers have the potential to aid with early detection. Substantial investment has been made into the development of biomarkers; however, studies are often carried out in specialist settings and few have been evaluated for low-prevalence populations. METHODS We aimed to identify novel biomarkers for the detection of lower GI cancers that have the potential to be evaluated for use in primary care. MEDLINE, Embase, Emcare and Web of Science were systematically searched for studies published in English from January 2000 to October 2019. Reference lists of included studies were also assessed. Studies had to report on measures of diagnostic performance for biomarkers (single or in panels) used to detect colorectal or anal cancers. We included all designs and excluded studies with fewer than 50 cases/controls. Data were extracted from published studies on types of biomarkers, populations and outcomes. Narrative synthesis was used, and measures of specificity and sensitivity were meta-analysed where possible. RESULTS We identified 142 studies reporting on biomarkers for lower GI cancers, for 24,844 cases and 45,374 controls. A total of 378 unique biomarkers were identified. Heterogeneity of study design, population type and sample source precluded meta-analysis for all markers except methylated septin 9 (mSEPT9) and pyruvate kinase type tumour M2 (TuM2-PK). The estimated sensitivity and specificity of mSEPT9 was 80.6% (95% CI 76.6-84.0%) and 88.0% (95% CI 79.1-93.4%) respectively; TuM2-PK had an estimated sensitivity of 81.6% (95% CI 75.2-86.6%) and specificity of 80.1% (95% CI 76.7-83.0%). CONCLUSION Two novel biomarkers (mSEPT9 and TuM2-PK) were identified from the literature with potential for use in lower-prevalence populations. Further research is needed to validate these biomarkers in primary care for screening and assessment of symptomatic patients.
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Affiliation(s)
- Paige Druce
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia.
| | - Natalia Calanzani
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Claudia Snudden
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kristi Milley
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Boscott
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Dawnya Behiyat
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Javiera Martinez-Gutierrez
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Smiji Saji
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jasmeen Oberoi
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Garth Funston
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mike Messenger
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Fiona M Walter
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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5
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Benton SC, Symonds E, Djedovic N, Jones S, Deprez L, Kocna P, Maria Auge J. Faecal immunochemical tests for haemoglobin: Analytical challenges and potential solutions. Clin Chim Acta 2021; 517:60-65. [PMID: 33571484 DOI: 10.1016/j.cca.2021.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
Quantitative faecal immunochemical tests for haemoglobin (FIT) are being used increasingly around the world in colorectal cancer screening programmes, and in patients presenting with lower bowel symptoms to determine who should proceed to further bowel visualisation investigations, usually colonoscopy. The clinical utility of FIT is well reported. There are a number of analytical challenges including pre-analytical variation, difficulty setting up external quality assessment schemes, access to third party internal quality control material and a lack of standardisation or harmonisation of FIT methods. Here we report the work of the International Federation of Clinical Chemistry FIT Working Group. We provide an overview of the main pre-analytical variables; discuss different approaches to external quality assurance of FIT; propose a solution to third party internal quality assurance materials and summarise the challenges of standardisation and harmonisation of FIT.
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Affiliation(s)
- Sally C Benton
- Clinical Biochemistry, Royal Surrey County Hospital/NHS Bowel Cancer Screening South of England Hub, Berkshire and Surrey Pathology Services, Guildford, Surrey, UK
| | - Erin Symonds
- Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia; Cancer Research, Flinders Health and Medical Research, Flinders University, Bedford Park, South Australia, Australia
| | - Natasha Djedovic
- Clinical Biochemistry/NHS Bowel Cancer Screening London Hub, London North West University Healthcare NHS Trust, UK
| | - Samantha Jones
- Weqas, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Liesbet Deprez
- European Commission, Joint Research Centre (JRC), Geel, Belgium
| | - Petr Kocna
- Laboratory of Gastroenterology, Institute of Medical Biochemistry and Laboratory Diagnostics, 1st.Medical Faculty of Charles University and General University Hospital, Prague, Czech Republic
| | - Josep Maria Auge
- Clinical Chemistry and Molecular Genetics Department, Hospital Clinic, Barcelona, Catalonia, Spain
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6
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O'Driscoll S, Carroll M, Maclean W, Piggott C, Jourdan I, Benton SC. Assessment of the analytical performance of point-of-care faecal immunochemical tests for haemoglobin. Ann Clin Biochem 2021; 58:181-189. [PMID: 33353372 DOI: 10.1177/0004563220986595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The faecal immunochemical test (FIT) detects the presence of haemoglobin (Hb) in faeces. It is used as a screening tool for colorectal cancer (CRC) and increasingly to triage patients presenting with symptoms of CRC. A number of quantitative point-of-care (POC) FIT systems marketed for professional use and intended for use in a clinical setting are available. Here we reviewed the POC FIT systems available; three (Eurolyser Cube, OC-Sensor iO and QuikRead go) were evaluated to assess their performance against manufacturers' claims and suitability for use in a clinical setting. METHODS The analytical evaluation of the POC FIT systems was undertaken using Hb lysates, patient samples and an external quality assessment sample. The evaluation focused on linearity, recovery, imprecision, prozone effect, Hb variant detection and suitability for use in a clinical setting. RESULTS All three POC FIT systems performed to their manufacturer's claims and demonstrated good analytical performance with acceptable linearity, recovery, within- and between-run imprecision. The QuikRead go and OC-Sensor iO were able to accurately detect samples with results above their measuring range. However, because of a prozone effect the Eurolyser Cube gave falsely low results when using high concentrations of Hb. The QuikRead go performed best in the usability assessment due to portability and timeliness of result. CONCLUSION Each system performed according to their manufacturers' claims. The QuikRead go and OC-Sensor iO are suitable for use. The Eurolyser Cube is not recommended because of the risk of falsely low results.
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Affiliation(s)
- Shane O'Driscoll
- Bowel Cancer Screening Programme, Southern Hub, Royal Surrey County Hospital, Guildford, UK.,Berkshire and Surrey Pathology Services, Guildford, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Magdalen Carroll
- Bowel Cancer Screening Programme, Southern Hub, Royal Surrey County Hospital, Guildford, UK.,Berkshire and Surrey Pathology Services, Guildford, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - William Maclean
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Carolyn Piggott
- Bowel Cancer Screening Programme, Southern Hub, Royal Surrey County Hospital, Guildford, UK.,Berkshire and Surrey Pathology Services, Guildford, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Iain Jourdan
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Sally C Benton
- Bowel Cancer Screening Programme, Southern Hub, Royal Surrey County Hospital, Guildford, UK.,Berkshire and Surrey Pathology Services, Guildford, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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7
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Chapman CJ, Banerjea A, Humes DJ, Allen J, Oliver S, Ford A, Hardy K, Djedovic N, Logan RF, Morling JR. Choice of faecal immunochemical test matters: comparison of OC-Sensor and HM-JACKarc, in the assessment of patients at high risk of colorectal cancer. Clin Chem Lab Med 2020; 59:721-728. [PMID: 33112776 DOI: 10.1515/cclm-2020-1170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
Objectives Currently, NICE recommends the use of faecal immunochemical test (FIT) at faecal haemoglobin concentrations (f-Hb) of 10 μg Hb/g faeces to stratify for colorectal cancer (CRC) risk in symptomatic populations. This f-Hb cut-off is advised across all analysers, despite the fact that a direct comparison of analyser performance, in a clinical setting, has not been performed. Methods Two specimen collection devices (OC-Sensor, OC-S; HM-JACKarc, HM-J) were sent to 914 consecutive individuals referred for follow up due to their increased risk of CRC. Agreement of f-Hb around cut-offs of 4, 10 and 150 µg Hb/g faeces and CRC detection rates were assessed. Two OC-S devices were sent to a further 114 individuals, for within test comparisons. Results A total of 732 (80.1%) individuals correctly completed and returned two different FIT devices, with 38 (5.2%) CRCs detected. Median f-Hb for individuals diagnosed with and without CRC were 258.5 and 1.8 µg Hb/g faeces for OC-S and 318.1 and 1.0 µg Hb/g faeces for HM-J respectively. Correlation of f-Hb results between OC-S/HM-J over the full range was rho=0.74, p<0.001. Using a f-Hb of 4 µg Hb/g faeces for both tests found an agreement of 88.1%, at 10 µg Hb/g faeces 91.7% and at 150 µg Hb/g faeces 96.3%. A total of 114 individuals completed and returned two OC-S devices; correlation across the full range was rho=0.98, p<0.001. Conclusions We found large variations in f-Hb when different FIT devices were used, but a smaller variation when the same FIT device was used. Our data suggest that analyser-specific f-Hb cut-offs are applied with regard to clinical decision making, especially at lower f-Hb.
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Affiliation(s)
- Caroline J Chapman
- Eastern Hub, Bowel Cancer Screening Programme, A Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Division of Cancer and Stem Cells, School of Medicine, Room W/D3, D Floor, West Block, Queen's Medical Centre, Nottingham, UK
| | - Ayan Banerjea
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David J Humes
- Nottingham Colorectal Service, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK
| | - Jaren Allen
- Division of Cancer and Stem Cells, School of Medicine, Room W/D3, D Floor, West Block, Queen's Medical Centre, Nottingham, UK
| | - Simon Oliver
- Nottingham City Clinical Commissioning Group, Nottingham, UK
| | - Abby Ford
- Eastern Hub, Bowel Cancer Screening Programme, A Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Katie Hardy
- Eastern Hub, Bowel Cancer Screening Programme, A Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Natasha Djedovic
- Eastern Hub, Bowel Cancer Screening Programme, A Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard F Logan
- Eastern Hub, Bowel Cancer Screening Programme, A Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK
| | - Joanne R Morling
- Eastern Hub, Bowel Cancer Screening Programme, A Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK
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8
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Murphy CC, Sen A, Watson B, Gupta S, Mayo H, Singal AG. A Systematic Review of Repeat Fecal Occult Blood Tests for Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2019; 29:278-287. [PMID: 31740521 DOI: 10.1158/1055-9965.epi-19-0775] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Screening with fecal occult blood tests (FOBT) reduces colorectal cancer mortality. Failure to complete repeat tests may compromise screening effectiveness. We conducted a systematic review of repeat FOBT across diverse health care settings. We searched MEDLINE, Embase, and the Cochrane Library for studies published from 1997 to 2017 and reported repeat FOBT over ≥2 screening rounds. Studies (n = 27 reported in 35 articles) measured repeat FOBT as (i) proportion of Round 1 participants completing repeat FOBT in Round 2; (ii) proportion completing two, consecutive FOBT; or (iii) proportion completing ≥3 rounds. Among those who completed FOBT in Round 1, 24.6% to 89.6% completed repeat FOBT in Round 2 [median: 82.0%; interquartile range (IQR): 73.7%-84.6%]. The proportion completing FOBT in two rounds ranged from 16.4% to 80.0% (median: 46.6%; IQR: 40.5%-50.0%), and in studies examining ≥3 rounds, repeat FOBT ranged from 0.8% to 64.1% (median: 39.2%; IQR: 19.7%-49.4%). Repeat FOBT appeared higher in mailed outreach (69.1%-89.6%) compared with opportunistic screening (24.6%-48.6%). Few studies examined correlates of repeat FOBT. In summary, we observed a wide prevalence of repeat FOBT, and prevalence generally declined in successive screening rounds. Interventions that increase and maintain participation in FOBT are needed to optimize effectiveness of this screening strategy.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas.
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Ahana Sen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Bianca Watson
- Department of Psychiatry and Behavioral Sciences, Tulane School of Medicine, New Orleans, Louisiana
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, UC San Diego, San Diego, California
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas Texas
| | - Amit G Singal
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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9
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Haas CB, Phipps AI, Hajat A, Chubak J, Wernli KJ. Time to fecal immunochemical test completion for colorectal cancer screening. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:174-180. [PMID: 30986014 PMCID: PMC7170013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Fecal immunochemical tests (FITs) can efficiently screen for colorectal cancer (CRC), but little is known on the timing to their completion. We investigate the time to return of a FIT following an order and describe patient characteristics associated with FIT return. STUDY DESIGN Retrospective cohort study. METHODS We identified 63,478 members of Kaiser Permanente Washington, aged 50 to 74 years, who received a FIT order from 2011 through 2012. Patient characteristics were ascertained through administrative and electronic health record data sources. We compared time from FIT order to return by patient characteristics using Kaplan-Meier and Cox regression methods. RESULTS About half (53.7%) of members completed a FIT. Median time from order to return was 13 days (mean, 44.5 days; interquartile range, 6-42 days). There was higher completion of FITs among Asian patients (hazard ratio [HR], 1.43; 95% CI, 1.38-1.48), black patients (HR, 1.13; 95% CI, 1.08-1.19), and Hispanic patients (HR, 1.10; 95% CI, 1.04-1.16) compared with white patients; among patients with recent CRC testing (vs no testing in past 2 years; HR, 1.90; 95% CI, 1.86-1.95); and among patients with Medicare insurance (vs commercial; HR, 1.30; 95% CI, 1.24-1.37). Factors associated with decreased FIT completion included younger age (50-54 years vs 70-74 years; HR, 0.87; 95% CI, 0.82-0.92), obesity (vs normal body mass index; HR, 0.88; 95% CI, 0.86-0.91), and higher Charlson Comorbidity Index score (≥3 vs 0; HR, 0.82; 95% CI, 0.79-0.87). CONCLUSIONS Time to return of FIT varies by patient characteristics. We observed greater FIT completion among people of color, suggesting that racial disparities in CRC may not be due to patient completion of the test after an order is received.
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Affiliation(s)
- Cameron B Haas
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101.
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10
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Nielson CM, Petrik AF, Jacob L, Vollmer WM, Keast EM, Schneider JL, Rivelli JS, Kapka TJ, Meenan RT, Mummadi RR, Green BB, Coronado GD. Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial. Cancer Med 2018; 7:4781-4790. [PMID: 30101513 PMCID: PMC6144161 DOI: 10.1002/cam4.1727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/06/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023] Open
Abstract
Annual fecal immunochemical testing (FIT) is cost-effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false-positive (FP) results adding to colonoscopy burden without improving cancer detection. Our objective was to describe FIT PPV and the factors associated with FP results among patients undergoing CRC screening. In an ongoing pragmatic clinical trial of mailed-FIT outreach, clinics delivered one of three FIT brands (InSure, OC-Micro, and Hemosure). Patients who had a positive FIT result and a follow-up colonoscopy were included in this analysis (N = 1130). Patients' demographic and medical histories were abstracted from electronic health records (EHR). Associations with a FP result (ie, a positive FIT result with no evidence of advanced neoplasia during follow-up colonoscopy) were evaluated for FIT brand and patient factors using mixed-effects multivariable logistic regression. The mean proportion of FIT-positive results ranged from 8% in centers using the OC-Micro test to 21% for Hemosure. PPVs for advanced neoplasia were 0.30 to 0.17, respectively (P for χ2 = 0.08). In multivariable-adjusted models, use of Hemosure was associated with greater odds of a FP result than OC-Micro (OR = 2.00, 95% CI: 0.47-8.56) or InSure (OR = 1.72, 95% CI: 0.44-6.68). However, only female sex (OR = 1.58, 95% CI: 1.19-2.10) and history of a colorectal condition (OR = 2.17, 95% CI: 1.13-4.15) were significantly associated with FP. In conclusion, FIT positivity varied by brand, and FP results differed by patient factors available through the EHR. These results can be used to minimize the frequency of FP results, reducing patient distress and colonoscopy burden.
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Affiliation(s)
| | | | | | | | - Erin M. Keast
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | | | | | - Tanya J. Kapka
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | | | | | - Beverly B. Green
- Kaiser Permanente Washington Health Research InstituteSeattleWashington
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Bevan R, Rutter MD. Colorectal Cancer Screening-Who, How, and When? Clin Endosc 2018; 51:37-49. [PMID: 29397655 PMCID: PMC5806924 DOI: 10.5946/ce.2017.141] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/20/2017] [Indexed: 12/17/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant, latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screening guidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, delivered opportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply to individuals 50-75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidence by detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult blood testing (gFOBt) was found to reduce CRC mortality by 13%-33%. Fecal immunochemical testing (FIT) has no RCT data comparing it to no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a 28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs, it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs are superior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organized programs using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.
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Affiliation(s)
- Roisin Bevan
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Durham, UK
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Durham, UK
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
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12
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Yang HY, Lin YM, Chong LW, Chang HC, Liao CS, Yang KC. Performance of quantitative immunochemical test for fecal hemoglobin for surveillance of colorectal neoplasia after polypectomy in clinical practice. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Hsin-Yeh Yang
- Division of Gastroenterology; Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan
| | - Yu-Min Lin
- Division of Gastroenterology; Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei Taiwan
| | - Lee-Won Chong
- Division of Gastroenterology; Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei Taiwan
| | - Hung-Chuen Chang
- Division of Gastroenterology; Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei Taiwan
| | | | - Kuo-Ching Yang
- Division of Gastroenterology; Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan
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13
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Shapiro JA, Bobo JK, Church TR, Rex DK, Chovnick G, Thompson TD, Zauber AG, Lieberman D, Levin TR, Joseph DA, Nadel MR. A Comparison of Fecal Immunochemical and High-Sensitivity Guaiac Tests for Colorectal Cancer Screening. Am J Gastroenterol 2017; 112:1728-1735. [PMID: 29016558 PMCID: PMC6077997 DOI: 10.1038/ajg.2017.285] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Annual testing using either a high-sensitivity guaiac fecal occult blood test (HS-gFOBT) or a fecal immunochemical test (FIT) is recommended for screening average-risk people for colorectal cancer. We compared the performance characteristics of the HS-gFOBT Hemoccult II SENSA and two FITs (InSure FIT and OC FIT-CHEK) for detecting advanced colorectal neoplasia. METHODS The study included 1,006 asymptomatic patients, aged 50-75 years, who were scheduled to receive a screening colonoscopy at gastroenterology practices in the Minneapolis and Indianapolis metropolitan areas. Each participant was asked to complete all three stool tests before their colonoscopy. Each test's performance characteristics were evaluated using the screening colonoscopic results as the reference standard. RESULTS Sensitivity for detecting advanced colorectal neoplasia was highest for InSure FIT (26.3%, 95% confidence interval (CI) 15.9-40.7), followed by OC FIT-CHEK (15.1%, 95% CI 6.7-26.1) and Hemoccult II SENSA (7.4%, 95% CI 1.9-17.0). InSure FIT was statistically significantly more sensitive than both OC FIT-CHEK (absolute difference in sensitivity=11.2%, 95% CI 0.4-24.2) and Hemoccult II SENSA (difference in sensitivity=18.9%, 95% CI 10.2-32.6). Specificities were relatively high for all tests (between 96.8% and 98.6%). CONCLUSIONS Our results suggest that some FITs are more sensitive than the HS-gFOBT Hemoccult II SENSA, but these results need to be confirmed in larger asymptomatic populations. Comparisons between the FITs examined in this study and other FITs are needed to determine the best tests for population screening.
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Affiliation(s)
- Jean A. Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet K. Bobo
- Battelle Health and Analytics, Seattle, Washington, USA
| | - Timothy R. Church
- Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Douglas K. Rex
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Gary Chovnick
- Battelle Health and Analytics, Seattle, Washington, USA
| | - Trevor D. Thompson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann G. Zauber
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Djenaba A. Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marion R Nadel
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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14
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Catomeris P, Baxter NN, Boss SC, Paszat LF, Rabeneck L, Randell E, Serenity ML, Sutradhar R, Tinmouth J. Effect of Temperature and Time on Fecal Hemoglobin Stability in 5 Fecal Immunochemical Test Methods and One Guaiac Method. Arch Pathol Lab Med 2017; 142:75-82. [PMID: 28967803 DOI: 10.5858/arpa.2016-0294-oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Although promising for colorectal cancer screening, hemoglobin (Hb) stability remains a concern with fecal immunochemical tests. This study implemented a novel, standardized method to compare Hb stability across various fecal immunochemical tests. The method can be used to inform decisions when selecting a kit for use in colorectal cancer screening. In so doing, this work addressed a critical need for standardization in this field. OBJECTIVE - To compare the stability of Hb across 5 different immunochemical kits and one guaiac kit. DESIGN - The stability of Hb was analyzed in collection devices inoculated with Hb-spiked feces and (1) stored at various temperatures (frozen, refrigerated, ambient, and elevated) for more than 60 days; (2) after undergoing 3 controlled, freeze-thaw cycles; and (3) after being transported by courier or postal services in uncontrolled temperature conditions from 3 locations in Ontario, Canada, to a central testing center. RESULTS - The stability of Hb varied with time and temperature and by kit. Lower Hb recoveries occurred with increasing temperature and increasing time from sample collection to testing. Refrigeration provided the best stability, although results varied across kits (eg, from 4.2 days to >60 days before a prespecified threshold [<70% probability of the test results remaining positive] was reached). Freeze-thaw stability varied across kits and cycles (Hb recoveries: NS Plus [Alfresa Pharma, Chuo-ku, Osaka, Japan], 91.7% to 95.4%; OC Diana [Eiken Chemical, Taito-ku, Tokyo, Japan], 57.6% to 74.9%). Agreement regarding Hb levels before and after transportation varied across kits (from 57% to 100%). CONCLUSIONS - Important differences in Hb stability were found across the included fecal immunochemical tests. These findings should inform practice-based and population-based colorectal cancer screening.
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Affiliation(s)
- Peter Catomeris
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
| | - Nancy N Baxter
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
| | - Sheila C Boss
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
| | - Lawrence F Paszat
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
| | - Linda Rabeneck
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
| | - Edward Randell
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
| | - Mardie L Serenity
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
| | - Rinku Sutradhar
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
| | - Jill Tinmouth
- From the Medical and Scientific Department, LifeLabs, Toronto, Ontario, Canada (Drs Catomeris and Boss); the Division of General Surgery, St Michael's Hospital, Toronto (Dr Baxter); the Departments of General Surgery (Dr Baxter), Radiation Oncology (Dr Paszat), and Medicine (Drs Rabeneck and Tinmouth), University of Toronto, Toronto; Prevention and Cancer Control, Cancer Care Ontario, Toronto (Drs Rabeneck and Tinmouth); the Division of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, Newfoundland, Canada (Dr Randell); Evaluative Clinical Sciences (Drs Paszat and Tinmouth and Ms Serenity) and Division of Gastroenterology (Dr Tinmouth), Sunnybrook Research Institute, Toronto; the Institute for Clinical Evaluative Sciences, Toronto (Drs Baxter, Paszat, Sutradhar, and Tinmouth); the Institute for Health Policy, Management and Evaluation (Drs Baxter, Paszat, and Tinmouth); and the Department of Biostatistics (Dr Sutradhar), Dalla Lana School of Public Health, University of Toronto, Toronto. Dr Boss is now retired
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15
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Projected effect of fecal immunochemical test threshold for colorectal cancer screening on outcomes and costs for Canada using the OncoSim microsimulation model. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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16
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Effects of Fecal Sampling on Preanalytical and Analytical Phases in Quantitative Fecal Immunochemical Tests for Hemoglobin. Int J Biol Markers 2017; 32:e261-e266. [DOI: 10.5301/ijbm.5000265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 12/18/2022]
Abstract
Background Information on preanalytical variability is mandatory to bring laboratories up to ISO 15189 requirements. Fecal sampling is greatly affected by lack of harmonization in laboratory medicine. The aims of this study were to obtain information on the devices used for fecal sampling and to explore the effect of different amounts of feces on the results from the fecal immunochemical test for hemoglobin (FIT-Hb). Methods Four commercial sample collection devices for quantitative FIT-Hb measurements were investigated. The volume of interest (VOI) of the probes was measured from diameter and geometry. Quantitative measurements of the mass of feces were carried out by gravimetry. The effects of an increased amount of feces on the analytical environment were investigated measuring the Hb values with a single analytical method. Results VOI was 8.22, 7.1 and 9.44 mm3 for probes that collected a target of 10 mg of feces, and 3.08 mm3 for one probe that targeted 2 mg of feces. The ratio between recovered and target amounts of devices ranged from 56% to 121%. Different changes in the measured Hb values were observed, in adding increasing amounts of feces in commercial buffers. Conclusions The amounts of collected materials are related to the design of probes. Three out 4 manufacturers declare the same target amount using different sampling volumes and obtaining different amounts of collected materials. The introduction of a standard probes to reduce preanalytical variability could be an useful step for fecal test harmonization and to fulfill the ISO 15189 requirements.
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Högberg C, Karling P, Rutegård J, Lilja M. Diagnosing colorectal cancer and inflammatory bowel disease in primary care: The usefulness of tests for faecal haemoglobin, faecal calprotectin, anaemia and iron deficiency. A prospective study. Scand J Gastroenterol 2017; 52:69-75. [PMID: 27623716 DOI: 10.1080/00365521.2016.1228120] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Abdominal complaints are common reasons to consult primary care but they are seldom caused by colorectal cancer (CRC), high-risk adenomas (HRAs), or inflammatory bowel disease (IBD). Reliable diagnostic aids would be helpful in deciding which patients to refer for bowel imaging. Our aim was to assess the value of a faecal immunochemical test (FIT) and a faecal calprotectin (FC) test in detecting CRC, HRAs and IBD in primary care, and the value of combining these tests with anaemia and iron-deficiency tests. MATERIALS AND METHODS This prospective study included 373 consecutive patients that received a FIT or a FC test ordered by a primary care physician. We collected samples for FITs, FC tests, full blood counts and iron-deficiency tests. Physicians were instructed to refer patients with a positive FIT or FC test (cut-off ≥100μg/g) for bowel imaging. The patients' presenting symptoms were recorded. Patients were followed for 2 years. RESULTS The best test for detecting CRC and IBD was the combination of the FIT and haemoglobin concentration. This test had a sensitivity, specificity, positive predictive value and negative predictive value of 100%, 61.7%, 11.7% and 100%, respectively. The FIT detected a significantly larger proportion of CRC, HRAs and IBD than the FC test (0.92 versus 0.46, 95% confidence interval 0.22-0.67). CONCLUSION A negative FIT combined with a normal haemoglobin concentration could rule out CRC and IBD with a high degree of safety. This could be useful in prioritising referrals for bowel imaging from primary care.
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Affiliation(s)
- Cecilia Högberg
- a Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital , Umeå University , Östersund , Sweden
| | - Pontus Karling
- b Department of Public Health and Clinical Medicine, Division of Medicine , Umeå University , Umeå , Sweden
| | - Jörgen Rutegård
- c Department of Surgical and Perioperative Sciences , Umeå University , Umeå , Sweden
| | - Mikael Lilja
- a Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital , Umeå University , Östersund , Sweden
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18
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Mowat C, Digby J, Strachan JA, Wilson R, Carey FA, Fraser CG, Steele RJC. Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms. Gut 2016; 65:1463-9. [PMID: 26294695 PMCID: PMC5036251 DOI: 10.1136/gutjnl-2015-309579] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/06/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In primary care, assessing which patients with bowel symptoms harbour significant disease (cancer, higher-risk adenoma or IBD) is difficult. We studied the diagnostic accuracies of faecal haemoglobin (FHb) and faecal calprotectin (FC) in a cohort of symptomatic patients. DESIGN From October 2013 to March 2014, general practitioners were prompted to request FHb and FC when referring patients with bowel symptoms to secondary care. Faecal samples were analysed for haemoglobin (EIKEN OC-Sensor io) and calprotectin (BÜHLMANN Calprotectin ELISA). Patients triaged to endoscopy were investigated within 6 weeks. All clinicians and endoscopists were blind to the faecal test results. The diagnostic accuracies of FHb and FC for identification of significant bowel disease were assessed. RESULTS 1043 patients returned samples. FHb was detectable in 57.6% (median 0.4 µg/g, 95% CI 0.4 to 0.8; range 0-200). FC at 50 µg/g or above was present in 60.0%. 755 patients (54.6% women, median age 64 years (range 16-90, IQR 52-73)) returned samples and completed colonic investigations. 103 patients had significant bowel disease; the negative predictive values of FHb for colorectal cancer, higher-risk adenoma and IBD were 100%, 97.8% and 98.4%, respectively. Using cut-offs of detectable FHb and/or 200 µg/g FC detected two further cases of IBD, one higher-risk adenoma and no additional cancers. CONCLUSIONS In primary care, undetectable FHb is a good 'rule-out' test for significant bowel disease and could guide who requires investigation.
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Affiliation(s)
- Craig Mowat
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, UK
| | - Jayne Digby
- Centre for Research into cancer Prevention and Screening
| | - Judith A Strachan
- Department of Blood Sciences, Ninewells Hospital & Medical School, Dundee, UK
| | - Robyn Wilson
- Department of Blood Sciences, Ninewells Hospital & Medical School, Dundee, UK
| | - Francis A Carey
- Department of Pathology, Ninewells Hospital & Medical School, Dundee, UK
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19
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Tinmouth J, Lansdorp-Vogelaar I, Allison JE. Faecal immunochemical tests versus guaiac faecal occult blood tests: what clinicians and colorectal cancer screening programme organisers need to know. Gut 2015; 64:1327-37. [PMID: 26041750 DOI: 10.1136/gutjnl-2014-308074] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/21/2015] [Indexed: 02/06/2023]
Abstract
Although colorectal cancer (CRC) is a common cause of cancer-related death, it is fortunately amenable to screening with faecal tests for occult blood and endoscopic tests. Despite the evidence for the efficacy of guaiac-based faecal occult blood tests (gFOBT), they have not been popular with primary care providers in many jurisdictions, in part because of poor sensitivity for advanced colorectal neoplasms (advanced adenomas and CRC). In order to address this issue, high sensitivity gFOBT have been recommended, however, these tests are limited by a reduction in specificity compared with the traditional gFOBT. Where colonoscopy is available, some providers have opted to recommend screening colonoscopy to their patients instead of faecal testing, as they believe it to be a better test. Newer methods for detecting occult human blood in faeces have been developed. These tests, called faecal immunochemical tests (FIT), are immunoassays specific for human haemoglobin. FIT hold considerable promise over the traditional guaiac methods including improved analytical and clinical sensitivity for CRC, better detection of advanced adenomas, and greater screenee participation. In addition, the quantitative FIT are more flexible than gFOBT as a numerical result is reported, allowing customisation of the positivity threshold. When compared with endoscopy, FIT are less sensitive for the detection of advanced colorectal neoplasms when only one time testing is applied to a screening population; however, this is offset by improved participation in a programme of annual or biennial screens and a better safety profile. This review will describe how gFOBT and FIT work and will present the evidence that supports the use of FIT over gFOBT, including the cost-effectiveness of FIT relative to gFOBT. Finally, specific issues related to FIT implementation will be discussed, particularly with respect to organised CRC screening programmes.
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Affiliation(s)
- Jill Tinmouth
- Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - James E Allison
- Division of Gastroenterology, University of California San Francisco, San Francisco, California, USA
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20
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Impact of Preanalytical Factors on Fecal Immunochemical Tests: Need for New Strategies in Comparison of Methods. Int J Biol Markers 2015; 30:e269-74. [DOI: 10.5301/jbm.5000150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 01/22/2023]
Abstract
Background Harmonization of fecal immunochemical tests for hemoglobin (FIT-Hb) is crucial to compare clinical outcomes in screening programs. The lack of reference materials and standard procedures does not allow the use of usual protocols to compare methods. We propose 2 protocols, based on artificial biological samples (ABS), to discriminate preanalytical and analytical variation and investigate clinical performances. The protocols were used to compare 2 FIT systems available on European markets: the OC-Sensor Diana (Eiken, Tokyo, Japan) and HM-JACKarc (Kyowa-Medex, Tokyo, Japan). Methods ABS were obtained adding Hb to Hb-free feces. In the first procedure, 35 ABS were collected for each collection device and analyzed on both systems. In the second, 188 ABS (106 positive and 82 negative) were collected and tested on the specific systems. Passing-Bablock (PB), Pearson's correlation coefficients (R) and Bland-Altman difference analysis were used to compare data. Results PB, R and mean standard errors for Bland-Altman analysis (Diana vs. Arc) results were 0.93x-0.56: R = 0.97 and 19%; and 1.09x + 5.60: R = 0.96 and −18%; for Diana and Arc devices, respectively. No correlations and no difference in positive/negative assessment were observed with the second protocol. Conclusions A good correlation was observed in comparing data generated using collection devices on the 2 systems. Manufacturers have developed different sample collection procedures for feces: therefore, data from different systems cannot easily be compared. Adoption of protocols to discriminate preanalytical and analytical variation would be a significant contribution to harmonization of FIT, facilitating data comparison and information acquisition for sample collection strategy and effect of buffers on systems.
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Phalguni A, Seaman H, Routh K, Halloran S, Simpson S. Tests detecting biomarkers for screening of colorectal cancer: What is on the horizon? GMS HEALTH TECHNOLOGY ASSESSMENT 2015; 11:Doc01. [PMID: 26131022 PMCID: PMC4466319 DOI: 10.3205/hta000122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aim: To identify new and emerging screening tests for colorectal cancer (CRC) that involves detection of various biomarkers like blood, DNA and RNA in samples of faeces, tissue or blood. Current practice: Screening for CRC can be done by bowel visualisation techniques and tests that measure biomarkers. The Bowel Cancer Screening Programme (BCSP) in England uses a guaiac faecal occult blood test. Methods: The strategy was to search available literature, identify developers and contact them for relevant information. Advice from experts was sought on potential utility and likely impact of identified technologies on the BCSP. Results: Ninety-three companies and five research groups were contacted. Sixty-nine relevant tests were identified. Detailed information was available for 48 tests, of these 73% were CE marked and the remainder were considered as emerging. Forty-nine tests use immunochemical methods to detect occult blood in faeces. Eight, four and two tests detect biomarkers in a sample of blood, or exfoliated cells either shed in faeces or collected from rectal mucosa respectively. Six tests were grouped as ‘other tests’. Most of the identified tests are performed manually and give qualitative detection of biomarkers. Conclusion: Variation in test performance and characteristics was observed amongst the 69 identified tests. Automated, quantitative FIT with a variable cut off are the preferred approach in the BSCP. However the units used to report FITs results do not enable comparison across products. Tests detecting biomarkers other than occult blood are more specific to neoplasms but have limited sensitivity due to the heterogeneity of cancer. Research is ongoing to identify an optimal panel of biomarkers, simplifying and automating the test, and reducing the cost.
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Affiliation(s)
- Angaja Phalguni
- NIHR Horizon Scanning Research & Intelligence Centre, School of Health and Population Sciences, University of Birmingham, United Kingdom
| | - Helen Seaman
- University of Surrey, NHS Bowel Cancer Screening Southern Programme Hub, United Kingdom
| | - Kristina Routh
- NIHR Horizon Scanning Research & Intelligence Centre, School of Health and Population Sciences, University of Birmingham, United Kingdom
| | - Stephen Halloran
- University of Surrey, NHS Bowel Cancer Screening Southern Programme Hub, United Kingdom
| | - Sue Simpson
- NIHR Horizon Scanning Research & Intelligence Centre, School of Health and Population Sciences, University of Birmingham, United Kingdom
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Daly JM, Bay CP, Xu Y, Levy BT. Effect of Ambient Temperature Variations on Positivity of Manual Fecal Immunochemical Tests. J Prim Care Community Health 2015; 6:243-9. [PMID: 26022208 DOI: 10.1177/2150131915588738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In the United States, many fecal occult blood tests are mailed by patients to a laboratory for analysis. Hemoglobin is not stable in feces and can be affected by the heat. Effects of season and ambient temperature on fecal immunochemical tests (FITs) have demonstrated a decrease in positivity rates during the hottest season. OBJECTIVE To investigate the potential effect of the average of 4-day ambient maximum temperature variations on the positivity of a single sample, one-time Clinical Laboratory Improvement Amendments (CLIA)-waived FIT. SETTING Midwestern tertiary care hospital. METHODS Individuals scheduled for a colonoscopy were invited to complete a qualitative FIT prior to their colonoscopy in 2010 and 2011. FITs were read as positive or negative. RESULTS Valid FITs were received from 1026 individuals over 25 months. The positivity rate was 10.9%. The mean 4-day average of daily maximum ambient temperatures was calculated including the day of receipt for each sample. Fahrenheit temperatures ranged from 16.0 to 96.8. Based on the odds ratio of 1.04 with a confidence interval of 0.94 to 1.14 for a 10°F increase in temperature, there was no statistically significant evidence of an effect of the preceding maximum average 4-day ambient temperature on FIT positivity. CONCLUSION No evidence was found that ambient temperature had an effect on positivity rate over a 25-month period using 4 different qualitative FIT products. Further analysis on effect of ambient temperatures is warranted for the automated FITs and CLIA-waived FITs, including liquid-vial and dry-slide FITs. Primary care providers need to be aware of potential adverse effects of FITs.
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Affiliation(s)
| | | | - Yinghui Xu
- The University of Iowa, Iowa City, IA, USA
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Fung KYC, Tabor B, Buckley MJ, Priebe IK, Purins L, Pompeia C, Brierley GV, Lockett T, Gibbs P, Tie J, McMurrick P, Moore J, Ruszkiewicz A, Nice E, Adams TE, Burgess A, Cosgrove LJ. Blood-based protein biomarker panel for the detection of colorectal cancer. PLoS One 2015; 10:e0120425. [PMID: 25793510 PMCID: PMC4368610 DOI: 10.1371/journal.pone.0120425] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/22/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The majority of colorectal cancer (CRC) cases are preventable by early detection and removal of precancerous polyps. Even though CRC is the second most common internal cancer in Australia, only 30 per cent of the population considered to have risk factors participate in stool-based test screening programs. Evidence indicates a robust, blood-based, diagnostic assay would increase screening compliance. A number of potential diagnostic blood-based protein biomarkers for CRC have been reported, but all lack sensitivity or specificity for use as a stand-alone diagnostic. The aim of this study was to identify and validate a panel of protein-based biomarkers in independent cohorts that could be translated to a reliable, non-invasive blood-based screening test. PRINCIPAL FINDINGS In two independent cohorts (n = 145 and n = 197), we evaluated seven single biomarkers in serum of CRC patients and age/gender matched controls that showed a significant difference between controls and CRC, but individually lack the sensitivity for diagnostic application. Using logistic regression strategies, we identified a panel of three biomarkers that discriminated between controls and CRC with 73% sensitivity at 95% specificity, when applied to either of the two cohorts. This panel comprised of Insulin like growth factor binding protein 2 (IGFBP2), Dickkopf-3 (DKK3), and Pyruvate kinase M2(PKM2). CONCLUSIONS Due to the heterogeneous nature of CRC, a single biomarker is unlikely to have sufficient sensitivity or specificity for use as a stand-alone diagnostic screening test and a panel of markers may be more effective. We have identified a 3 biomarker panel that has higher sensitivity and specificity for early stage (Stage I and -II) disease than the faecal occult blood test, raising the possibility for its use as a non-invasive blood diagnostic or screening test.
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Affiliation(s)
- Kim Y. C. Fung
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
| | - Bruce Tabor
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
| | - Michael J. Buckley
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
| | - Ilka K. Priebe
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
| | - Leanne Purins
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
| | - Celine Pompeia
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
| | - Gemma V. Brierley
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
| | - Trevor Lockett
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
| | - Peter Gibbs
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jeanne Tie
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - James Moore
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Edouard Nice
- Monash University, Melbourne, Victoria, Australia
| | - Timothy E. Adams
- CSIRO Materials Science & Engineering, Parkville, Victoria, Australia
| | - Antony Burgess
- Walter and Eliza Hall Institute for Medical Research, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Victoria, Australia
| | - Leah J. Cosgrove
- CSIRO Preventative Health National Research Flagship, Adelaide, South Australia, Australia
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24
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How to improve the performances of Fecal Immunological Tests (FIT): Need for standardization of the sampling and pre-analytical phases and revision of the procedures for comparison of methods. Int J Biol Markers 2015; 30:e127-31. [PMID: 24855037 DOI: 10.5301/jbm.5000093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 11/20/2022]
Abstract
Lack of reference materials and standard procedures, on faecal tests leads to major problems in harmonisation of methods and do not allow the comparison of outcome data. In particular the absence of standardisation of pre-analytical characteristic was noted for faecal test methods for haemoglobin since different manufacturers have developed different sampling procedures and report units. Moreover the physical characteristics of the faecal specimen and the designs of specimen collection devices do not allow analysis of samples on different systems in consequence, faecal tests cannot be compared using standard evaluation protocols. To improve the harmonization of results generated using different analytical systems and the overall performances of test on faecal materials we propose the introduction of standard procedures for sampling and pre-analytical phase and the adoption of specific procedures based on the use of artificial biological samples for comparison of methods. Harmonization of sampling devices with the use of a standard design for pickers and a standard ratio between analyte and buffer for different manufacturers represent a mandatory step in the roadmap for harmonization of clinical laboratory measurement on faecal materials and can allow a significant standardisation of results generated by different devices.The creation of specific protocols for the evaluation and comparison of analytical methods for analyse of faeces could lead to a significant improvement in the performance of methods and systems.
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Abstract
Screening for premalignant lesions or early invasive disease has the potential to reduce mortality from cancer. Because of their ease of measurement, several biomarkers have been evaluated or are currently undergoing evaluation as screening tests for early malignancy. These include the use of AFP in screening for hepatocellular cancer in high-risk subjects, CA 125 in combination with transvaginal ultrasound (TVU) in screening for epithelial ovarian cancer, PSA in screening for prostate cancer, faecal occult blood testing (FOBT) in screening for colorectal cancer (CRC) and vanillymandelic acid and homovanillic acid in screening for neuroblastoma in newborn infants, Of these biomarkers, only the use of FOBT in screening for CRC has unequivocally been shown to reduce mortality from cancer. Although 2 large randomized prospective trials have evaluated PSA as a screening test for prostate cancer, it is still unclear whether the benefits outweigh the harms in this setting. Although biomarkers have many attractive features as cancer screening tests, lack of sensitivity and specificity, when combined with the low prevalence of specific cancer types in asymptomatic subjects, limit their application for the early detection of malignancy.
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Affiliation(s)
- Michael J Duffy
- Clinical Research Centre, St Vincent's University Hospital, Elm Park, Dublin, 4, Ireland.
- UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, 4, Ireland.
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26
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Abstract
UNLABELLED There is a wide choice of fecal occult blood tests (FOBTs) for colorectal cancer screening. GOAL To highlight the issues applicable when choosing a FOBT, in particular which FOBT is best suited to the range of screening scenarios. Four scenarios characterize the constraints and expectations of screening programs: (1) limited colonoscopy resource with a need to constrain test positivity rate; (2) a priority for maximum colorectal neoplasia detection with little need to constrain colonoscopy workload; (3) an "adequate" endoscopy resource that allows balancing the benefits of detection with the burden of service provision; and (4) a need to maximize participation in screening. Guaiac-based FOBTs (gFOBTs) have significant deficiencies, and fecal immunochemical tests (FITs) for hemoglobin have emerged as better tests. gFOBTs are not sensitive to small bleeds, specificity can be affected by diet or drugs, participant acceptance can be low, laboratory quality control opportunities are limited, and they have a fixed hemoglobin concentration cutoff determining positivity. FITs are analytically more specific, capable of quantitation and hence provide flexibility to adjust cutoff concentration for positivity and the balance between sensitivity and specificity. FITs are clinically more sensitive for cancers and advanced adenomas, and because they are easier to use, acceptance rates are high. CONCLUSIONS FOBT must be chosen carefully to meet the needs of the applicable screening scenario. Quantitative FIT can be adjusted to suit Scenarios 1, 2 and 3, and for each, they are the test of choice. FITs are superior to gFOBT for Scenario 4 and gFOBT is only suitable for Scenario 1.
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Wong MCS, Ching JYL, Chan VCW, Shum JP, Lam TYT, Luk AKC, Sung JJY. Should prior FIT results be incorporated as an additional variable to estimate risk of colorectal neoplasia? A prospective study of 5,813 screening colonoscopies. PLoS One 2014; 9:e114332. [PMID: 25479102 PMCID: PMC4257562 DOI: 10.1371/journal.pone.0114332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/06/2014] [Indexed: 02/06/2023] Open
Abstract
Background Recent studies showed that previous negative results from faecal immunochemical tests (FITs) for colorectal cancer (CRC) screening was associated with lower risk of advanced neoplasia (AN). We evaluated whether prior FIT results should be included to estimate the risk of AN in 2008–2012. Methods A community-based screening practice recruited 5,813 asymptomatic residents aged 50 to 70 years in Hong Kong for CRC screening. We included study participants who had (1). positive FIT with subsequent colonoscopy workup (FIT+ group; n = 356); (2). negative FIT in three consecutive years and received a colonoscopy (FIT- group; n = 857); (3). received colonoscopy without FIT (colonoscopy group; n = 473); and (4). received both colonoscopy and FIT at the same time (combined group; n = 4,127). One binary logistic regression model evaluated whether prior FIT results were associated with colonoscopy findings of AN. Results The proportion of participants having AN/CRC was 18.0% (FIT+), 5.5% (FIT-), 8.0% (colonoscopy group), and 4.3% (combined group), respectively. When compared with the colonoscopy group, those in the FIT- group were not significantly more or less likely to have AN/CRC (AOR = 0.77, 95% C.I. = 0.51 to 1.18, p = 0.230). Having one (AOR = 0.73, 95% C.I. 0.48–1.12, p = 0.151) or three consecutive negative FIT result (AOR = 0.98, 95% C.I. 0.60–1.62, p = 0.944) were not associated with lower risks of AN/CRC. Subjects in the FIT+ group was 3.32-fold (95% C.I. 2.07 to 5.32, p<0.001) more likely to have AN/CRC. Conclusions These findings indicated that subjects with negative FIT findings could be risk stratified similarly as those who had not previously received FIT.
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Affiliation(s)
- Martin C. S. Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
| | - Jessica Y. L. Ching
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Victor C. W. Chan
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Jeffrey P. Shum
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Y. T. Lam
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Arthur K. C. Luk
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J. Y. Sung
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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28
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Chausserie S, Levillain R, Puvinel J, Ferrand O, Ruiz A, Raginel T, Lantieri O, Launoy G, Guittet L. Seasonal variations do not affect the superiority of fecal immunochemical tests over guaiac tests for colorectal cancer screening. Int J Cancer 2014; 136:1827-34. [DOI: 10.1002/ijc.29187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/06/2014] [Accepted: 08/12/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Sébastien Chausserie
- Centre Hospitalier Universitaire (CHU) de Caen, Evaluations et recherches en épidémiologie; Caen
- Normandie University; Caen
- Université de Caen Basse-Normandie (UCBN), Cancers and Preventions; Caen
- INSERM U1086, Cancers and preventions; Caen
| | - Romuald Levillain
- Institut InterRégional pour la Santé (IRSA) de Tours, Centre de lecture des tests de recherche de sang dans les selles; La Riche France
| | - Josette Puvinel
- Association Bourbonnaise Interdépartementale de Dépistage des Cancers (ABIDEC); Moulins
| | - Olivier Ferrand
- Action de Dépistage Organisé des Cancers 18 (ADOC18); Saint-Doulchard
| | - Angela Ruiz
- Institut InterRégional pour la Santé (IRSA) de Tours, Centre de lecture des tests de recherche de sang dans les selles; La Riche France
| | - Thibaut Raginel
- Centre Hospitalier Universitaire (CHU) de Caen, Evaluations et recherches en épidémiologie; Caen
- Normandie University; Caen
- Université de Caen Basse-Normandie (UCBN), Cancers and Preventions; Caen
- INSERM U1086, Cancers and preventions; Caen
| | - Olivier Lantieri
- Institut InterRégional pour la Santé (IRSA) de Tours, Centre de lecture des tests de recherche de sang dans les selles; La Riche France
| | - Guy Launoy
- Centre Hospitalier Universitaire (CHU) de Caen, Evaluations et recherches en épidémiologie; Caen
- Normandie University; Caen
- Université de Caen Basse-Normandie (UCBN), Cancers and Preventions; Caen
- INSERM U1086, Cancers and preventions; Caen
| | - Lydia Guittet
- Centre Hospitalier Universitaire (CHU) de Caen, Evaluations et recherches en épidémiologie; Caen
- Normandie University; Caen
- Université de Caen Basse-Normandie (UCBN), Cancers and Preventions; Caen
- INSERM U1086, Cancers and preventions; Caen
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29
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Duffy MJ, Lamerz R, Haglund C, Nicolini A, Kalousová M, Holubec L, Sturgeon C. Tumor markers in colorectal cancer, gastric cancer and gastrointestinal stromal cancers: European group on tumor markers 2014 guidelines update. Int J Cancer 2014; 134:2513-22. [PMID: 23852704 PMCID: PMC4217376 DOI: 10.1002/ijc.28384] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/25/2013] [Indexed: 02/06/2023]
Abstract
Biomarkers currently play an important role in the detection and management of patients with several different types of gastrointestinal cancer, especially colorectal, gastric, gastro-oesophageal junction (GOJ) adenocarcinomas and gastrointestinal stromal tumors (GISTs). The aim of this article is to provide updated and evidence-based guidelines for the use of biomarkers in the different gastrointestinal malignancies. Recommended biomarkers for colorectal cancer include an immunochemical-based fecal occult blood test in screening asymptomatic subjects ≥50 years of age for neoplasia, serial CEA levels in postoperative surveillance of stage II and III patients who may be candidates for surgical resection or systemic therapy in the event of distant metastasis occurring, K-RAS mutation status for identifying patients with advanced disease likely to benefit from anti-EGFR therapeutic antibodies and microsatellite instability testing as a first-line screen for subjects with Lynch syndrome. In advanced gastric or GOJ cancers, measurement of HER2 is recommended in selecting patients for treatment with trastuzumab. For patients with suspected GIST, determination of KIT protein should be used as a diagnostic aid, while KIT mutational analysis may be used for treatment planning in patients with diagnosed GISTs.
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Affiliation(s)
- MJ Duffy
- Clinical Research Center, St Vincent’s University Hospital, Dublin 4 and UCD School of Medicine and Medical Science, Conway Institute, University College DublinDublin, Ireland
| | - R Lamerz
- Medical Department II, Klinikum Grosshadern, Med. Klinik IIMunich, Germany
| | - C Haglund
- Department of Surgery, Helsinki University Central HospitalHelsinki, Finland
| | - A Nicolini
- Department of Oncology, University of PisaPisa, Italy
| | - M Kalousová
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University in Prague and General University Hospital in PraguePrague, Czech Republic
| | - L Holubec
- Department of Oncology and Radiotherapy, University Hospital of PilsenPilsen, Czech Republic
| | - C Sturgeon
- Department of Clinical Biochemistry, Royal Infirmary of EdinburghEdinburgh, United Kingdom
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30
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Turgeon DK, Ruffin MT. Screening strategies for colorectal cancer in asymptomatic adults. Prim Care 2014; 41:331-53. [PMID: 24830611 DOI: 10.1016/j.pop.2014.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides an update for the primary care community on the evidence and recommendations for colorectal cancer screening in the adult population without symptoms at average and increased risk, excluding patients with high-risk genetic syndromes. The current and possible new screening strategies are reviewed, along with clinical wisdom related to the implementation of each method.
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Affiliation(s)
- D Kim Turgeon
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Mack T Ruffin
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213, USA.
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31
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Carroll MRR, Seaman HE, Halloran SP. Tests and investigations for colorectal cancer screening. Clin Biochem 2014; 47:921-39. [PMID: 24769265 DOI: 10.1016/j.clinbiochem.2014.04.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/11/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022]
Abstract
Worldwide, colorectal (CRC) is the third most common form of cancer, after lung and breast cancer, and the fourth most common cause of cancer death, although in developed countries CRC incidence is higher and it accounts for an even higher proportion of cancer deaths. Successful treatment of early-stage CRC confers substantial survival advantage, and there is now overwhelming evidence that screening average-risk individuals for CRC reduces the incidence and disease-specific mortality. In spite of considerable research for new biomarkers for CRC, the detection of blood in faeces remains the most effective screening tool. The best evidence to date for population-based CRC screening comes from randomised-controlled trials that used a guaiac-based faecal occult blood test (gFOBt) as the first-line screening modality, whereby test-positive individuals are referred for follow-up investigations, usually colonoscopy. A major innovation in the last ten years or so has been the development of other more analytically sensitive and specific screening techniques for blood in faeces. The faecal immunochemical test for haemoglobin (FIT) confers substantial benefits over gFOBt in terms of analytical sensitivity, specificity and practicality and FIT are now recommended for CRC screening by the European guidelines for quality assurance in colorectal cancer screening and diagnosis. The challenge internationally is to develop high quality CRC screening programmes for which uptake is high. This is especially important for developing countries witnessing an increase in the incidence of CRC as populations adopt more westernised lifestyles. This review describes the tests available for CRC screening and how they are being used worldwide. The reader will gain an understanding of developments in CRC screening and issues that arise in choosing the most appropriate screening test (or tests) for organised population-based screening internationally and optimising the performance of the chosen test (or tests). Whilst a wide range of literature has been cited, this is not a systematic review. The authors provide FOBT CRC screening for a population of 14.6 million in the south of England and the senior author (SPH) was the lead author of the European guidelines for quality assurance in colorectal cancer screening and diagnosis and leads the World Endoscopy Organization Colorectal Cancer Committee's Expert Working Group on 'FIT for Screening'.
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Affiliation(s)
- Magdalen R R Carroll
- NHS Bowel Cancer Screening Programme Southern Hub, 20 Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YS, UK; Royal Surrey County Hospital Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX, UK.
| | - Helen E Seaman
- NHS Bowel Cancer Screening Programme Southern Hub, 20 Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YS, UK; Royal Surrey County Hospital Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX, UK; University of Surrey, Guildford, GU2 7XH, UK.
| | - Stephen P Halloran
- NHS Bowel Cancer Screening Programme Southern Hub, 20 Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YS, UK; Royal Surrey County Hospital Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX, UK; University of Surrey, Guildford, GU2 7XH, UK.
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32
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Allison JE, Fraser CG, Halloran SP, Young GP. Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin (FIT). Gut Liver 2014; 8:117-30. [PMID: 24672652 PMCID: PMC3964261 DOI: 10.5009/gnl.2014.8.2.117] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/04/2014] [Indexed: 12/12/2022] Open
Abstract
Fecal immunochemical tests for hemoglobin (FIT) are changing the manner in which colorectal cancer (CRC) is screened. Although these tests are being performed worldwide, why is this test different from its predecessors? What evidence supports its adoption? How can this evidence best be used? This review addresses these questions and provides an understanding of FIT theory and practices to expedite international efforts to implement the use of FIT in CRC screening.
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Affiliation(s)
- James E Allison
- Division of Gastroenterology, University of California San Francisco School of Medicine, San Francisco, CA, USA. ; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee School of Medicine, Dundee, Scotland
| | - Stephen P Halloran
- NHS Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital and University of Surrey, Guildford, UK
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park SA, Australia
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33
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Brenner H, Hoffmeister M, Birkner B, Stock C. Diagnostic performance of guaiac-based fecal occult blood test in routine screening: state-wide analysis from Bavaria, Germany. Am J Gastroenterol 2014; 109:427-35. [PMID: 24343548 DOI: 10.1038/ajg.2013.424] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/10/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Randomized trials have shown that annual or biannual screening by guaiac-based fecal occult blood tests (gFOBTs) reduces colorectal cancer (CRC) mortality. Few clinical studies have evaluated diagnostic performance of gFOBT through validation by colonoscopy in all participants. We aimed for a comprehensive evaluation of diagnostic performance of gFOBT by age and sex under routine screening conditions. METHODS Our analysis is based on 20,884 colonoscopies following up a positive gFOBT and 182,956 primary screening colonoscopies documented in a state-wide quality assurance program in Bavaria, Germany, in 2007-2009. Positive likelihood ratios (LR+), which represent an integrative measure of diagnostic performance, were derived, by age groups (55-59, 60-64, 65-69, 70-74 years) and sex, from a joint and comparative analysis of prevalences of colorectal neoplasms in both groups. RESULTS Overall LR+ (95% confidence intervals) were 1.11 (1.06-1.15), 1.80 (1.72-1.88), and 5.04 (4.64-5.47) for non-advanced adenoma, advanced adenoma, and cancer, respectively. Assuming a specificity of gFOBT of 95.2%, as recently observed in a German study among 2,235 participants of screening colonoscopy, these LR+ would translate to sensitivities of 5.3%, 8.6%, and 24.2% for the three outcomes, respectively. Diagnostic performance was similarly poor among women and men and across age groups. CONCLUSIONS The performance of gFOBT under routine screening conditions is even worse than previously estimated from clinical studies. In routine screening application, gFOBTs are expected to miss more than 9 out of 10 advanced adenomas and 3 out of 4 cancers. These results underline the need and the potential for better noninvasive CRC screening tests.
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Affiliation(s)
- Hermann Brenner
- 1] Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany [2] German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Berndt Birkner
- 1] Gastroenterology Practice, Munich, Germany [2] Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Christian Stock
- 1] Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany [2] Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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Fraser CG, Allison JE, Young GP, Halloran SP, Seaman H. A standard for Faecal Immunochemical TesTs for haemoglobin evaluation reporting (FITTER). Ann Clin Biochem 2013; 51:301-2. [PMID: 24345727 DOI: 10.1177/0004563213514392] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Scotland
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Liao CS, Lin YM, Chang HC, Chen YH, Chong LW, Chen CH, Lin YS, Yang KC, Shih CH. Application of quantitative estimates of fecal hemoglobin concentration for risk prediction of colorectal neoplasia. World J Gastroenterol 2013; 19:8366-8372. [PMID: 24363529 PMCID: PMC3857461 DOI: 10.3748/wjg.v19.i45.8366] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/15/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the role of the fecal immunochemical test (FIT), used to evaluate fecal hemoglobin concentration, in the prediction of histological grade and risk of colorectal tumors.
METHODS: We enrolled 17881 individuals who attended the two-step colorectal cancer screening program in a single hospital between January 2010 and October 2011. Colonoscopy was recommended to the participants with an FIT of ≥ 12 ngHb/mL buffer. We classified colorectal lesions as cancer (C), advanced adenoma (AA), adenoma (A), and others (O) by their colonoscopic and histological findings. Multiple linear regression analysis adjusted for age and gender was used to determine the association between the FIT results and colorectal tumor grade. The risk of adenomatous neoplasia was estimated by calculating the positive predictive values for different FIT concentrations.
RESULTS: The positive rate of the FIT was 10.9% (1948/17881). The attendance rate for colonoscopy was 63.1% (1229/1948). The number of false positive results was 23. Of these 1229 cases, the numbers of O, A, AA, and C were 759, 221, 201, and 48, respectively. Regression analysis revealed a positive association between histological grade and FIT concentration (β = 0.088, P < 0.01). A significant log-linear relationship was found between the concentration and positive predictive value of the FIT for predicting colorectal tumors (R2 > 0.95, P < 0.001).
CONCLUSION: Higher FIT concentrations are associated with more advanced histological grades. Risk prediction for colorectal neoplasia based on individual FIT concentrations is significant and may help to improve the performance of screening programs.
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Immunochemical fecal occult blood test for detection of advanced colonic adenomas and colorectal cancer: comparison with colonoscopy results. Gastroenterol Res Pract 2013; 2013:384561. [PMID: 24319453 PMCID: PMC3844264 DOI: 10.1155/2013/384561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/26/2013] [Indexed: 12/14/2022] Open
Abstract
Background. Fecal immunochemical tests (FITs) have been used for colorectal cancer (CRC) screening in several countries. There is lack of information concerning diagnostic performances of this method in Brazil. Methods. Patients scheduled for elective colonoscopy provided one stool sample one week before colonoscopy. The accuracy of a qualitative FIT for detection of CRC and advanced adenomas was determined. Results. Overall 302 patients completed the study. Among them, 53.5% were high risk patients referred for screening or surveillance. Nine (3%) CRCs and 11 (3.6%) advanced adenomas were detected by colonoscopy. Sensitivity and specificity for CRC were, respectively, 88.9% and 87.6%. For advanced adenomas, sensitivity was 63.6% and specificity 87.6%. Conclusion. Our results showed good sensitivity and specificity of the FIT for detecting advanced neoplasias. This method may be a valuable tool for future screening programs in Brazil.
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Abstract
Colorectal cancer (CRC) is a common, but preventable, disease and is the second most common cause of cancer-related deaths in the U.S. CRC screening has proven effective at reducing both the incidence and mortality of this disease, using any of a number of screening tests available. The test options range from the least invasive and least expensive to more invasive and costly options. Fecal occult blood testing is the oldest, least expensive, and least invasive of these options and has evolved from the poorly sensitive standard guaiac test to the newer and diagnostically superior fecal immunochemical test (FIT) for hemoglobin. This article explores the evolutionary history of fecal occult blood testing, examines test performance characteristics among different FOBTs, and evaluates the role of the FIT in programmatic CRC screening.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, 3D-5, San Francisco, CA, 94110, USA,
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Kocna P, Vanickova Z, Zima T. Laboratory screening markers in gastroenterology - state of the art. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157:91-7. [DOI: 10.5507/bp.2013.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 04/10/2013] [Indexed: 11/23/2022] Open
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Brenner H, Tao S. Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. Eur J Cancer 2013; 49:3049-54. [PMID: 23706981 DOI: 10.1016/j.ejca.2013.04.023] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/22/2013] [Accepted: 04/26/2013] [Indexed: 02/06/2023]
Abstract
There is increasing evidence that faecal immunochemical tests (FITs) for haemoglobin offer a number of advantages over traditional guaiac based faecal occult blood tests (gFOBTs). However, evidence on diagnostic performance from direct comparisons with colonoscopy findings in all participants in the average risk population is still sparse. We aimed for a head-to-head comparison of three quantitative FITs with a gFOBT among participants of the German screening colonoscopy programme. Pre-colonoscopy stool samples and colonoscopy reports were obtained from 2235 participants of screening colonoscopy in 2005-2009. To enhance comparability of diagnostic performance of the various tests, we assessed sensitivity, specificity, predictive values and likelihood ratios of FITs after adjusting the FIT cut-off haemoglobin (Hb) concentrations in such a way that FIT positivity rates equalled the positivity rate of the gFOBT. Colorectal cancer, advanced adenomas and other adenomas were found in 15 (0.7%), 207 (9.3%) and 398 (17.8%) participants. The gFOBT was positive in 111 (5.0%) participants, with sensitivities (specificities) for detecting colorectal cancer, any advanced neoplasm or any neoplasm of 33.3% (95.2%), 8.6% (95.4%) and 5.5% (95.2%). At the same positivity rate, all three FITs outperformed the gFOBT in all indicators. In particular, all sensitivities of FITs were approximately two to three times higher at increased levels of specificity. All differences were statistically significant, except for some of the performance indicators for colorectal cancer. In conclusion, FITs can detect much larger proportions of colorectal neoplasms even if their cut-offs are set to levels that ensure equally low positivity rates as gFOBT.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld, 69120 Heidelberg, Germany.
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Raginel T, Puvinel J, Ferrand O, Bouvier V, Levillain R, Ruiz A, Lantieri O, Launoy G, Guittet L. A population-based comparison of immunochemical fecal occult blood tests for colorectal cancer screening. Gastroenterology 2013; 144:918-25. [PMID: 23376426 DOI: 10.1053/j.gastro.2013.01.042] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/17/2013] [Accepted: 01/22/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Quantitative fecal immunochemical tests (FITs) identify individuals with colorectal cancer with greater levels of accuracy than guaiac tests. We compared the performances of 2 FITs in a population undergoing screening for colorectal cancer. METHODS We collected fecal samples from 19,797 individuals in France (age, 50-74 y) who participated in a colorectal cancer screening program, from June 2009 through May 2011. Samples were analyzed using the Magstream (Fujirebio Inc, Tokyo, Japan) and OC Sensor (Eiken Chemical Co, Tokyo, Japan) (2 samples each) FITs, as well as the Hemoccult II guaiac test (SKD, Villepinte, France) (3 samples each). Colonoscopies were performed for patients with positive results from all 3 tests. The cut-off values for levels of hemoglobin in buffer and stools were 55 ng/mL and 180 μg/g for the Magstream and 150 ng/mL and 30 μg/g for the OC Sensor, respectively. Results from the FITs were compared with those from the guaiac test for cut-off values for stool samples, positivity rates, and the receiver operating characteristic curve values. The numbers needed to screen and the numbers needed to scope to detect an advanced neoplasia (cancer, adenoma ≥10 mm, or high-grade dysplasia) were calculated. RESULTS A positive test result was found in 1224 participants (6.2%); 1075 (87.8%) underwent a colonoscopy examination. Of these, 334 were found to have advanced neoplasia. Considering the cut-off values associated with the positivity rate of Hemoccult II (1.6%), the numbers needed to screen were 239 for Hemoccult II, 166 for a 1-sample Magstream FIT, and 129 for a 1-sample OC Sensor FIT; the numbers needed to scope were 3.3, 2.3, and 1.8, respectively. For the same false-positive rate as Hemoccult II (0.98%), the true-positive rates for Magstream and OC Sensor FITs were 0.65% and 0.90% respectively, compared with 0.42% for Hemoccult II. The OC Sensor FIT had a greater area under the receiver operating characteristic curve value than the Magstream FIT. CONCLUSIONS Based on results from a large, population-based study, the OC Sensor FIT identifies patients with colorectal cancer with greater accuracy than the Magstream FIT. ClinicalTrials.gov number: NCT01251666.
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Affiliation(s)
- Thibaut Raginel
- Centre Hospitalier Universitaire (CHU) de Caen, Caen, France; Normandie University, Caen, France
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McDonald PJ, Digby J, Innes C, Strachan JA, Carey FA, Steele RJC, Fraser CG. Low faecal haemoglobin concentration potentially rules out significant colorectal disease. Colorectal Dis 2013. [PMID: 23199241 DOI: 10.1111/codi.12087] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM The study aimed to determine whether faecal haemoglobin (Hb) concentration can assist in deciding who with lower abdominal symptoms will benefit from endoscopy. METHOD Faecal Hb concentrations were measured on single samples from 280 patients referred for lower gastrointestinal tract endoscopy from primary care in NHS Tayside who completed a faecal immunochemical test (FIT) for Hb and underwent subsequent endoscopy. RESULTS Among 739 invited patients, FIT and endoscopy were completed by 280 (median age 63 (18-84) years; 59.6% women), with a median time between FIT and endoscopy of 9 days. Six (2.1%) participants had cancer, 23 (8.2%) had high-risk adenoma (HRA) (more than three adenomas or any > 1 cm), 31 (11.1%) low-risk adenoma (LRA) and 26 (9.3%) inflammatory bowel disease (IBD) as the most serious diagnosis. Those with cancer had a median faecal Hb of > 1000 ng Hb/ml buffer. Those with cancer + HRA + IBD had a median faecal Hb concentration of 75 ng Hb/ml buffer (95% CI 18-204), which was significantly higher than that of all remaining participants without significant colorectal disease (P < 0.0001). Using a cut-off faecal Hb concentration of 50 ng Hb/ml buffer, negative predictive values of 100.0%, 94.4%, 93.4% and 93.9% were found for cancer, HRA, LRA and IBD. Patients with reasons for referral other than rectal bleeding and family history did not have high faecal Hb concentrations. CONCLUSION Faecal Hb concentration measurements have considerable potential to contribute to reducing unnecessary endoscopy for the majority of symptomatic patients.
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Affiliation(s)
- P J McDonald
- Scottish Bowel Screening Centre, Kings Cross Hospital, Dundee, UK
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42
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Fraser CG. A future for faecal haemoglobin measurements in the medical laboratory. Ann Clin Biochem 2012; 49:518-26. [PMID: 22949730 DOI: 10.1258/acb.2012.012065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Guaiac-based faecal occult blood tests (gFOBT) are still used in asymptomatic population bowel screening programmes but are being replaced by faecal immunochemical tests (FIT) for haemoglobin. gFOBT have many well-documented disadvantages and there is little evidence for their use in assessment of the symptomatic. Many laboratories have eliminated gFOBT from their approved repertoires by invoking the authoritative published guidelines. Data continue to accumulate that gFOBT are obsolete. FIT are available in two formats, qualitative and quantitative, the latter having advantages that the faecal haemoglobin concentrations are measured and cut-off concentrations that stimulate further investigation can be user-defined. There is growing evidence that FIT would be useful in a spectrum of clinical settings in addition to screening. All laboratories should have FIT in their existing repertoire. For some uses, qualitative FIT would be adequate. However, much evidence has accumulated that measurements of faecal haemoglobin concentrations are beneficial for the assessment of both disease severity and the future risk of colorectal neoplasia. Interpretation requires appreciation that faecal haemoglobin concentrations are higher in men than women and rise with age. It might well be that risk scoring systems that take gender and age into account, possibly with other factors including symptoms, will benefit individuals. Laboratories should consider how quantitative faecal haemoglobin measurements could be brought into routine practice and included in their forward planning. External quality assessment is needed. Specialists in laboratory medicine are urged to play a significant role in the research and development still required to make this a truly mature investigation.
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Affiliation(s)
- Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland.
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Fraser CG, Allison JE, Young GP, Halloran SP. Newer Fecal Tests: Opportunities for Professionals in Laboratory Medicine. Clin Chem 2012; 58:963-5. [DOI: 10.1373/clinchem.2012.185025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland
| | - James E Allison
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Graeme P Young
- Flinders Centre for Cancer Prevention and Control, Flinders University, Bedford Park, Australia
| | - Stephen P Halloran
- Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital and University of Surrey, Guildford, UK
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Fraser CG, Allison JE, Halloran SP, Young GP. A proposal to standardize reporting units for fecal immunochemical tests for hemoglobin. J Natl Cancer Inst 2012; 104:810-4. [PMID: 22472305 DOI: 10.1093/jnci/djs190] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Fecal immunochemical tests for hemoglobin are replacing traditional guaiac fecal occult blood tests in population screening programs for many reasons. However, the many available fecal immunochemical test devices use a range of sampling methods, differ with regard to hemoglobin stability, and report hemoglobin concentrations in different ways. The methods for sampling, the mass of feces collected, and the volume and characteristics of the buffer used in the sampling device also vary among fecal immunochemical tests, making comparisons of test performance characteristics difficult. Fecal immunochemical test results may be expressed as the hemoglobin concentration in the sampling device buffer and, sometimes, albeit rarely, as the hemoglobin concentration per mass of feces. The current lack of consistency in units for reporting hemoglobin concentration is particularly problematic because apparently similar hemoglobin concentrations obtained with different devices can lead to very different clinical interpretations. Consistent adoption of an internationally accepted method for reporting results would facilitate comparisons of outcomes from these tests. We propose a simple strategy for reporting fecal hemoglobin concentration that will facilitate the comparison of results between fecal immunochemical test devices and across clinical studies. Such reporting is readily achieved by defining the mass of feces sampled and the volume of sample buffer (with confidence intervals) and expressing results as micrograms of hemoglobin per gram of feces. We propose that manufacturers of fecal immunochemical tests provide this information and that the authors of research articles, guidelines, and policy articles, as well as pathology services and regulatory bodies, adopt this metric when reporting fecal immunochemical test results.
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